1. National Picture on Homecare Services Mark Hackett CEO Southampton University Hospitals NHS Trust

2. Current position of homecare services A rapidly growing market in England @ £1 billion Established companies with new market entrants Considerable benefits of homecare services Need to address key market, taxpayers, patients and NHS The NHS needs to be a more co-ordinated customer to maximise potential of homecare Southampton University Hospitals NHS Trust

3. What are key issues in market? Homecare market conditions NHS Trust/PCTs Patients Effective organisation and delivery of homecare Taxpayers Governance Southampton University Hospitals NHS Trust

4. Market issues Differing levels of provider concentration in rapidly growing markets with new entrants Risks are high for certain providers Relatively weak contractual, governance and operational control mechanisms Procurement mechanisms need transparency, co-ordination and sensible commercial arrangements Two principle routes of homecare supply – Manufacturer only homecare route – Homecare provision from manufacturer or wholesaler Need to see homecare services as part of local health system strategy Southampton University Hospitals NHS Trust

5. Governance issues Role of Trust Chief Pharmacists, Medical Directors and Nurse Directors needs to strengthen around homecare services Internal Trust governance systems need improvement Better integration between NHS Trusts and homecare to:- – Improve business processes – Set minimum standards for provider accreditation – NHS needs to improve operational control processes – Improve working with local commissioners Southampton University Hospitals NHS Trust

6. Collaboration across organisations Need for better NHS Trust/commissioning alignment to improve patient services Incentivisation of homecare providers to:- – Reduce transaction costs – Improve cost of whole healthcare system – Management of homecare demand – Improve patient services National or regional collaboration needed to incentivise NHS providers and commissioners to collaborate More open procurement models needed with homecare providers Southampton University Hospitals NHS Trust

7. Towards a vision for the future More stability for new and existing homecare providers by collaborative purchasing and longer term contracts Stable contractual frameworks which are of sufficient duration to secure best value for patients and taxpayers Homecare suppliers should be prepared to take proportionate risks to invest in new technology, service levels and cost efficacy. Consider separating homecare services and supplies of medicines to get clarity on provision Integrated governance with NHS provider as the customer Homecare providers and NHS should have a set of industry standards which cover major areas of governance, operational control and approaches A form of “kite mark” accreditation to enter into NHS contacts Southampton University Hospitals NHS Trust

8. Acute providers Strengthened roles for Trust Chief Pharmacists, Medical and Nurse Directors around homecare – Set strategy, annual programme of account to Trust CEO – Identify patient cohorts – Pharmacy only prescribing – Resourcing homecare admin and use of pharmacy systems – Responsible Officer status for Chief Pharmacist for homecare – External scope to other areas, e.g. HPN Southampton University Hospitals NHS Trust

9. Providers should purchase on national or regional collaboratives for homecare service supplies, based on:- – National NHS contract – Common sense specifications – Clarity on what is national or regional – Formula between Trust and commissioners on sharing savings Southampton University Hospitals NHS Trust

10. Better use of incentives and opportunities – Secondments from NHS provider to homecare – Improved clarity of responsibility for GPs, patients, Trusts, etc – Use of local DTC to approve homecare plans and strategies – Greater involvement of patients – Incentivising homecare supply – Transparency around profit and costs Southampton University Hospitals NHS Trust

11. Commissioning Collaborative commissioning and procurement with NHS providers Improving strategic focus by:- – Homecare services fitting into strategy for chronic disease or stable disease models – Whole life cycle costs of homecare service across hospital, community and primary care – 3 year strategy for non-tariff/tariff therapies – Even-way share with NHS Trusts on value release Integration with local Trust models for improved transaction costs Southampton University Hospitals NHS Trust

12. Patients Explicit service guarantee with NHS Trust and homecare provider Greater choice Patient involvement in strategy, planning and marketing contracts Individual patient involvement in service contract:- – Release time – Link with transaction systems – Satisfaction recording – Governance processes Southampton University Hospitals NHS Trust